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Wednesday, January 26, 2011

Virtual Book Tour: Dr. Gary Small

Today we are delighted to welcome Gary Small, M.D., director of the UCLA Memory and Aging Center and professor of psychiatry at UCLA's David Geffen School of Medicine. He'll be answering our questions - and yours as well - about the book he recently wrote with his wife, Gigi Vorgan, "The Naked Lady Who Stood On Her Head: A Psychiatrist's Stories of His Most Bizarre Cases."

Nourishing Relationships: Several of the stories in your book deal with how the mind affects the body. One of them gets into your experiences with the “Fainting Schoolgirls.” What is mass hysteria? Is it a common phenomenon?Gary Small: In the “Fainting Schoolgirls” incident, I was investigating an outbreak of illness in a suburban grade school. The kids were rehearsing a performance, when suddenly 30 of them grabbed their stomachs and fainted. The principal told me that it started with one popular child who fainted and suddenly the rest of them went down like dominoes. The health department couldn’t find a cause and gave the “all clear,” but the community was in an uproar. The school seemed to be blocking my efforts to get to the bottom of things, and the parents took offense that a psychiatrist was suggesting that their kids might have had a psychosomatic illness. I nearly gave up my study until I attended the actual show – a little worried that the outbreak might recur – when one of the mothers sought me out and supported my theory of mass hysteria – she was convinced that her daughter’s physical symptoms were in fact psychological. My subsequent research proved my theory that when stressed out, the mind can make the body sick, and in a group setting, it can really get out of control.

When we face uncertainty, our minds crave explanations. If we have no way to account for symptoms, we feel out of control and our fear escalates. And, if we learn that our own minds may have caused these very real symptoms, we tend to feel more anxiety about what our minds might do next. People may worry that their brains are possessed by some outside spirit, or perhaps a poltergeist has taken charge of their willpower. They’d rather latch onto something like the mysterious poisonous water theory. In all the mass hysteria episodes I’ve studied and written about over the years, the lingering question for me is why they don’t happen more often. The essential ingredients – groups under psychological and physical stress, often hungry, tired, or both – come together almost daily all around the world.

NR: Why are people afraid of psychiatrists?

GS: There is clearly a stigma about “seeing a shrink” and admitting one has a problem. Sometimes people are in denial about their mental struggles and avoid or even attack psychiatry in an attempt to avoid anyone discovering their secret psychological issues. Also, mental illness is often perceived as a weakness. Many people still believe that they should be able to solve their problems on their own. Yet, in any given year, an estimated one of four adults—nearly 60 million people in the U.S—suffer from a mental disorder and most of them don’t get help, which is why it is so important for people to try to get beyond their fears.

Psychiatrists are sometimes viewed as probing mental detectives who take control of their patients’ minds rather than heal them. In my book, I attempt to debunk such misconceptions and demystify the treatment of mental illness. Despite the public’s misconceptions, psychiatric treatments diminish and often eradicate symptoms of psychosis, depression, and anxiety. Systematic studies have shown that often combining medicine and psychotherapy results in significant improvement.

NR: Why do you need a therapist if you can talk to a good friend?

GS: A psychiatrist or therapist, unlike a friend, has no agenda of their own when listening. When a friend gives you advice, he may be thinking about how your actions will affect him, as well as you. When you’re in therapy, it’s all about you, not the therapist. Also, anything you tell a therapist is strictly confidential, and unless your friend has the training, you may not be getting the greatest advice. Having good friends is important to our mental health, but if you need it, don’t hesitate to call a professional.

NR: In your book, one of the cases involves a woman who develops a so-called “serial addiction.” What exactly is that and is it really possible?

GS: When we think of addition, alcohol or drugs usually comes to mind, but a person can get addicted to almost anything they enjoy: food, tobacco, sex, gambling, the Internet, or even video games. Some people have addictive personalities. When they “kick the habit” of one thing, they simply move on to something new and get addicted to that. In The Naked Lady Who Stood on Her Head, a woman who has an eating disorder overcomes it. Then, her shopping gets out of control, and she just can’t stop until she moves on to something else. This kind of serial addict usually exhibits the same behavior patterns regardless of the object of their current addiction: They crave the experience all the time, have withdrawal when they can’t get it, are secretive and defensive about the behavior, and the addiction interferes with everyday life. Anyone who’s struggled with addiction or dependency, should be aware of the possibility of becoming hooked on something new.

NR: Another case involves a patient who discovers that her husband has a second wife and family. You give that as an example of a sociopath. How do you define sociopath and how can we tell if someone has that personality disorder?

GS: Sociopaths are people who think only of themselves. They have no conscience or empathy. Whether it’s an Bernie Madoff, Adolf Hitler or Charles Manson, they wreak havoc on other people’s lives. But what about the everyday sociopath who sneaks into your life and befriends you? When you discover his true colors, you’re shocked, you feel violated, and you often blame yourself for being duped. How can you spot these predators before they gain your trust?

First impressions count. If someone does not seem genuine, your impression may be accurate. Also, watch out for people who seem too good to be true. Sociopaths often anticipate your needs in order to get what they really want. Finally, look for typical character traits: no sense of remorse, short-tempered and quick to blame others, and few or no long-term relationships. Remember, sociopaths can be smart and even when you’re on alert, they can slip into your life. Don’t blame yourself, just cut them out and move on.

Thanks so much, Gary! You've given us bites of a delicious idea feast. Now, readers, it's up to you if you want more - he's ready to answer your questions. Just click on 'comments' at the bottom of this post and follow the prompts. If you don't have an account you can sign in as 'anonymous' - it's as easy as that!

18 Comments:

Anonymous said...

It seems as if so many of the awful multiple killings, like the ones in Tucson a few weeks ago, are committed by schizophrenics. You say that often people with mental illness never get treatment. How can we change that?

Mass hysteria occurs a lot more than people imagine. Any time a group of individuals gathers under stress, the possibility of psychosomatic symptoms spreading by sight or sound or both is possible. Examples have been epidemics of polio-like illnesses in hospital settings, fainting and nausea in school children, and respiratory symptoms in office workers.-Gary Small

There's so much reported about normal memory loss with aging and other more serious illnesses like Alzheimers and dementia. How can someone in their mid-50s set their mind at ease, short of doing a complete evaluation? Karen

About 1% of the population suffers from schizophrenia, a chronic psychotic illness that devastates lives. Treatments are available but access and funding are a challenge. Public education to overcome the stigma about psychiatry and psychiatric treatment, as well as funding for more treatment facilities would help improve access to treatment.-Gary Small

The cases I read about bullying break my heart. Although my kids are still in preschool, I'm already worrying about how to emotionally protect them. I would appreciate your thoughts about this. Gillian

I think that kids clearly spend too much time online. The Kaiser Family Foundation study recently reported that on average, young people (ages 8 - 18 years) spend more than 11 hours daily using their technology. They are wiring their brains for efficient use of technology, but weaking neural circuits controlling face-to-face communication skills.-Gary Small

My husband is 67 and getting increasingly forgetful. He retired at 62 and used to be sociable and involved with hobbies. This past year he has lost interest in almost everything and has become dependent on me. When I try to talk about it he gets angry. We don't have children so I'm on my own. Any ideas about how to encourage him to see a doctor?

Deciding if memory complaints are a normal part of aging or something more ominous can be a challenge even for doctors. If your memory challenges are worrying you and/or they seem to be interferring with everyday life then I suggest talking with your physician. If it requires treatment, then the earlier you get started, the better the outcome.-Gary Small

Writing "The Naked Lady Who Stood on Her Head" with my wife Gigi was great for both of us. I learned a lot about narrative writing, and Gigi learned about what it's like to be a psychiatrist. What helps our collaboration is that each of us brings a different point of view to the project, and we have fun working with each other.-Gary Small

I haven't seen the study about increased risk of suicide in boys whose parents have divorced, but I do know that there have been several studies showing that loss in childhood, whether from divorce or death in the family, can lead to sensitivity to future losses and risk for mental symptoms. In fact, our study of the outbreak of mass hysteria that we describe in our new book was found to support this observation. Children more likely to develop symptoms of mass hysteria were also more likely to have experienced parental divorce or a death in the family.-Gary Small

I think the best way to help our kids with bullying is to make it safe for them to talk about their feelings with us. Parents can model how to do that with each other and encourage their kids to talk about feelings and concerns. If you have a concern about your own kid, you might invite a teachable moment relating one of your own experiences of being bullied as a child and how you dealt with it.-Gary Small

ALTHOUGH TECHNOLOGY OFFERS US MANY BENEFITS THE NEED TO BALANCE USE OF TECHNOLOGY AND HUMAN RELATIONSHIP SKILLS IS BECOMING MORE APPARENT. AS THE POPULATION AGES BOTH SOCIALIZING SKILLS AND TECHNOLOGY SKILLS ARE IMPORTANT TOOLS. HOWEVER MEMORY IS KEY. WHAT ADVISE DO YOU HAVE FOR PEOPLE TO ENHANCE THEIR MEMORY SKILLS AS THEY AGE?

People can use technology to enhance their memory skills as they age. Several groups have developed online and offline computer games that can improve cognitive abilities. Also, we can use the Internet as an external hard drive to augment our memory abilities as we age.-Gary Small